Mar 21, 2013 1:12 PM

Hey everyone. I love running. It keeps me sane and it makes me feel great. About a month and a half ago I started having severe knee pain, so bad I couldn't run past 2 miles. I took a few weeks off, stretched, and ran again, and it still hurt. So I went to the orthopedist and the chiropractor. I was diagnosed with chondromalacia patella. Now I'm in the process of setting up an appointment with a physical therapist so that I can start running again in the future without further injury. I don't want to stop running, but I still don't understand what I was doing wrong, so I feel like I'm probably going to injure myself again.

Every week I run 3 miles (on a treadmill) on Monday, Wednesday, and Friday. I've been doing this for probably 5 years now (off and on due to shin splits which are not a problem anymore due to toe-taps before each run). I have never run more than 3 miles. I'd rather go faster than farther, so every week I bump up my mph by .1. Cardiovascularly, I can handle this. I feel like I'm right at my limit, and it feels great. I also weight train (legs and arms) on Mondays and Thursdays, and I do some sort of cross training one time on most weeks (elliptical, stair stepper, P90X tape, etc.)

My orthopedist told me I got chonrdomalacia patella from violating the golden rule of running - "don't do too much, too soon, too often, too fast, too hard, with too little rest." But I don't understand how I violated that rule. How is 9 miles/week too much when people who train for marathons do 30+ miles/week? How is 3x/week too often when online running plans advise people to run 5 days/week? How is bumping up by .1 mph/week too fast? and how is running every other day, and taking both weekend days off too little rest??? I don't understand it. Can someone shed some light on this situation?

The ortho mentioned one possible reason, but there can be a preponderance of factors, each of which might not matter as much by itself. In your case, we have the medical opinion that you violated that rule, but something else may have prevented you from recovering from what you may consider a slight violation if any.

While you are at the PT, see if you can get a detailed critique of your running style on the treadmill (make sure this particular PT is qualified and experienced in running analysis, or find another for that part). You may even consider a critique of the treadmill you have been using. They are not all equal, and some cause more injuries than others.

I'll hazard a guess about the rule and the .1mph. I don't think it is the degree of change, but that it seems to have always represented a progressive change, meaning the body may not have finished adapting to one change before the challenge was increased. Successful programs often include downward as well as upward challenges. In this case, the knee may have always been unstable, because it never got a chance to settle into a routine. Here, there was no doubt a practical limit to how much your cadence could increase, so stride length increased until failure. It may have been the only way to increase your speed. Sure, it feels good until something breaks.

If you did not increase your stride length in terms of leg angle, your loft would have to increase to keep you airborne longer. That could also be hard on the knee. A history of on-off shin splints points to flirting with a practical limit to your training.

The best antidote to this trend, would be to accept an occasional respite from progressive challenge, trusting your body to continue to catch up with adaptations at the rate with which you actually recover. In other words, you continue to get stronger because you back off, after which you can pick up the challenge again. There is no hard and fast rule that applies to everybody, but you have at least found a limit that applies to you.

I would find a pool and do some aqua jogging for at least 30 minutes a day and also do some leg strengthening activities that can be found at Jason Fitzgerald or Jay Johnson's site. If you'd like a specific regimen put together to attack these issues instead of react to them please contact me at teachtorun.com.

Blogging about motivation, injury prevention and training lessons I've learned at TeachtoRun.com and working on "The Ultimate 5k Plan" at HowtoRun5k.com.

Thanks so much for your response! I have verified that my PT does do gait analysis.

It seems that my practical limit is around the 6.6-6.7mph range on the treadmill. This seems pretty quick since I'm only 5'3", but I'd love to get past that threshold! I read somewhere that a good rule to follow when trying to increase speed or distance is to continue increasing and every 3 weeks decrease your speed/distance drastically (sort of an "off week") to allow your body to recover. Does this sound like something you'd suggest for me?